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A 40 year old woman on chronic haemodialysis experienced repeated vascular access problems. A Permcath was inserted via the left internal jugular vein with its luminal end in the right atrium. Eight months later progressive malfunction occurred and thrombotic adhesions were diagnosed by echocardiography. As patency could not be achieved by urokinase infusion, the patient was referred for angiographic examination. The images show the result of contrast injection into one lumen of the catheter and revealed the reason for the malfunction. The flexible catheter tip (arrow) was displaced to the coronary sinus (CS) and wedged in the middle cardiac vein (MCV). Due to the elevated venous pressure on the haemodialysis circuit the small cardiac vein (SCV) was dilated abnormally and marked the right atrioventricular groove. The Permcath was explanted without complications and replaced by a new catheter from the right side. Dysfunction of luminal venous catheters may arise for various reasons. Malposition into the middle cardiac vein may be easily detected by angiography, avoiding potentially harmful treatment measures such as thrombolysis.

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